Thomas Petnehazy

Analysis of dog bites in children who are younger than 17 years

OBJECTIVES. This study focuses on the pattern of incidence, mechanisms, and circumstances of accident and injury in a series of pediatric patients who sustained dog bites. METHODS. In our retrospective survey, the medical charts of all children who were younger than 17 years and sought medical attention after a dog bite between 1994 and 2003 were reviewed. To obtain the total number of each dog breed in the administrative district, we analyzed 5873 files from the community dog registers. For establishment of a risk index, the representation of a dog breed among the total canine population was divided by the frequency of dog bites from this breed. RESULTS. A total of 341 children (mean age: 5.9 years) were identified. The annual incidence of dog bites was 0.5 per 1000 children between 0 and 16 years of age. Incidence was highest in 1-year-old patients and decreased with increasing age. The relative risk for a dog attack by a German shepherd or a Doberman was ∼5 times higher than that of a Labrador/retriever or cross-breed. The vast majority (82%) of the dogs were familiar to the children. Most (322; 94%) of the children had injuries to 1 body region; in the remaining 19 (6%) children, up to 3 body regions were injured. Of 357 injuries, the face, head, and neck region was the leading site affected (50%). Inpatient treatment was required in 93 (27%) patients. CONCLUSIONS. Dog bites in children are frequent and influenced by the breed-related behavior of dogs, dog owners, children, and parents. Therefore, prevention strategies should focus on public education and training of dogs and their owners. Children who are younger than 10 years represent the high-risk group for dog attacks.

Evaluation of fractures in children and adolescents in a Level I Trauma Center in Austria.

BACKGROUND Injury represents a major concern for children and adolescents worldwide. It is estimated that 10% to 25% of all pediatric injuries will result in fractures. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of fractures in childhood in a Level I Trauma Center in Austria. METHODS Children managed with fractures between December 2004 and October 2006 were prospectively evaluated. Patients were divided into four age groups: infants (<1 year), preschool children (1-6 years), school-aged children (6-14 years), and adolescents (>14 years). RESULTS The study included 3,339 patients younger than 19 years, who presented with 3,421 fractures. There was a male predominance (61.3%, n = 2,096). Girls (38.7%, n = 1,325) had a lower mean age at presentation of 8.2 years (boys, 9.8 years). An increase in the incidences of fractures was observed until a peak of 11 years in girls and 12 years in boys. A majority of fractures occurred in sports facilities (34.7%), followed by those at home (17.6%) and outdoors (16.7%). The most frequent mechanisms were falls on level surface (41.9%), falls from a height <3 m (23.2%), and involuntary contact with persons or objects (18.2%). The most common fractures were those of the distal radius (15.3%), followed by those of the finger (14%) and distal forearm fractures (8%). CONCLUSION As the Department of Pediatric Surgery in Graz serves as the referral center at least for nearly all major pediatric fractures in the Austrian state of Styria, mechanisms and patterns of major fractures in this study can serve as the basis for state-wide pediatric injury prevention efforts. These prevention strategies should not aim to reduce the level of exposure but should increase the risk awareness and encourage children and their parents to use necessary precautions.

Galeazzi Lesions in Children and Adolescents: Treatment and Outcome

A Galeazzi fracture is defined as a fracture of the radius associated with dislocation of the distal radioulnar joint. Treatment in children and adolescents is usually possible with closed reduction and casting. The objective of this retrospectively designed study was to describe all Galeazzi lesions treated at our department during a 3-year period. One hundred ninety-eight patients with displaced fractures of the radius alone or both bones of the forearm were reviewed. In 26 (13%) cases, a Galeazzi lesion was found and these patients formed the study group. Outcome was assessed using the Gartland-Werley score. Eight of 26 (31%) fractures were recognized initially and classified as a Galeazzi lesion. Casting after fracture reduction was possible in 22 patients. Thirteen patients were treated with immobilization in a below-elbow cast and nine with an above-elbow cast. Four patients were treated operatively. The results were excellent in 23 cases and good in three cases. In cases of distal forearm fractures, a possible Galeazzi lesion should be considered. However, proper reduction of the radius with concomitant reduction of the distal radioulnar joint and cast immobilization provides good to excellent outcome even if the Galeazzi lesion is primarily not recognized.Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Single-port appendectomy in obese children: an optimal alternative?

Introduction:  The aim of this study was to evaluate our experience with single‐port appendectomy (SPA) in obese children.

Analysis of 347 kindergarten-related injuries

While it has been shown that non-parental childcare is associated with a reduced risk for unintentional injuries, a considerable number of accidents in kindergartens do result in severe injuries. We have collected data on the behavioral and environmental aspects of accidents that occurred in kindergartens in Austria with the aim of determining possible prevention measures. Included in the study were all kindergarten-related injuries (347) from among 21,582 pediatric trauma cases treated in a 22-month period in Graz, Austria. Kindergarten-related injuries that were treated during the same period at six participating hospitals located throughout Austria were used for comparision. A questionnaire was completed at first attendance, and additional information was achieved by interviews with the parents and kindergarten teachers. Only the 347 kindergarten accidents that occurred in Graz were analyzed in detail. Half of the injuries occurred in an outdoor environment (outside), even though most of the time was spent indoors. Boys were more frequently involved in accidents than girls (male:female = 3:2). We identified seasonal and circadian differences, with most children being injured during the first 2 months of attendance (September and October), during the first 3 days of the week (Monday to Wednesday) and in the hour before and after lunch, respectively. Of the 347 accidents analyzed, 24% resulted in serious injury, and injuries occurring outdoors were more severe than those occurring indoors. Most parents felt that the accidents were unpreventable (47%), while 18% stated that improved supervision may have prevented the accident. Kindergarten accidents in Austria still result in a significant number of severe injuries. Kindergarten injuries were related to gender, season, time of day and location. Our results indicate the necessity of a continuous child safety training program that involves the participation of all teachers in day-care functions.

Transdermal uptake and organ distribution of silver from two different wound dressings in rats after a burn trauma

Silver‐containing wound dressings are an integral part of wound therapy in adult and pediatric burn patients. The antimicrobial effect of silver is well known and has been described in numerous studies. Side effects are rarely reported from silver‐containing wound care products, even though systemic absorption of silver has been shown by elevated levels of silver in the blood of patients after silver exposure during wound therapy. This animal study investigated the silver levels of blood and in which organs and tissues silver is detectable after long‐term application of silver‐containing wound dressings after a burn trauma. In male rats, a major full‐thickness scald was created on their backs according to a standardized burn model. Two different silver‐containing wound dressings (nanocrystalline silver [NCS] and silver sulphate foam [SSF]) were applied initially and changed every 7 days. Weekly blood drawings revealed an increase of blood silver in week three with significant higher values in the SSF compared with NCS group (Ag μg/kg 135.8 vs. 61.7; means; p ≤ 0.05). Thereafter, the NCS group showed significantly higher blood silver levels than the SSF group at week five (Ag μg/kg 192.3 vs. 81.3; means; p ≤ 0.01) and six (Ag μg/kg 168.2 vs. 32.9; means; p ≤ 0.01). After 6 weeks, the animals were sacrificed, and the organs and tissues were analyzed for their silver content by inductively coupled plasma mass‐spectrometry. Silver was detectable in all analyzed organs and tissue samples, with higher silver values in parenchymatous organs in the NCS than SSF group (Ag μg/kg; spleen: 3,469 vs. 260; kidney: 3,186 vs. 289; liver: 2,022 vs. 313; means; p ≤ 0.05). Silver was also detectable in brain, testis, lung, heart, and muscle tissue.

Ulnar polydactyly — An analysis of appearance and postoperative outcome

BACKGROUND/PURPOSE Ulnar polydactylies present with a wide variation in the size and appearance of the affected finger, ranging from small cutaneous appendages to fully formed additional fingers. Since ulnar polydactyly is rarely associated with functional disabilities, psychological and cosmetic reasons are the main rationale for surgical treatment. The aim of this study was to present the appearance, treatment regimen, and outcome of a series of children treated with ulnar polydactylies. METHODS Data of all pediatric patients treated between 2000 and 2010 were included. For assessing long-term outcome, patients were contacted via mail and asked to complete a questionnaire concerning location and appearance of the scar as well as functional and cosmetic satisfaction (VAS 0-100). RESULTS In that period, 32 patients (20 male, 12 female) with 53 ulnar polydactylies were treated. In 20 patients the polydactyly occurred bilaterally (63%), in 10 patients on the left side (31%), and 2 patients presented with right-sided ulnar polydactyly (6%). The vast majority of ulnar polydactylies were floating cutaneous appendages. The mean age of the patients at operation was 8.6 months (range 0 to 10 years). 20 patients (63%) responded to the postal questionnaire. Follow-up time was 4.9 years (range 2.1 to 10 years). The majority of patients reported a flat scar (n=18, 90%). Mean overall satisfaction with the postoperative result using a VAS 0-100 score was 89. CONCLUSION We were able to report a good postoperative outcome of a series of patients suffering from ulnar polydactylies.

Fractures of the hallux in children.

Background: Foot fractures account for 5% to 13% of pediatric fractures. Fractures of the hallux require special attention due to its role in weight bearing, balance, and pedal motion. In this study, a large series of children with hallux fractures is presented. Methods: All children treated with fractures of the hallux between June 2004 and December 2011 were included. The medical records were analyzed and X-rays were reviewed. The fractures were classified according to their anatomic location and the type of fracture. Three hundred seventeen patients (mean age = 11.7 years; range, 1-18 years; 65% male) sustained a fracture of the hallux. Results: Most accidents (28%) occurred at sports facilities, and soccer was the most common cause of a fracture of the hallux (28%). Closed injuries were diagnosed in 92% of the patients; 8% of the children presented with open fractures. In 144 children, the growth plate was affected. Fifty-nine patients presented with diaphyseal fractures, 42 patients with osseous avulsions, and 40 patients with fractures of the distal part of the phalanx. Nineteen children had incomplete and 13 patients comminuted fractures. The vast majority of the children (86%) were treated conservatively. Operative interventions were required in 14% of the patients. Good outcome was achieved in both conservatively and operatively treated patients. Conclusion: In children, fractures of the hallux were most often caused by ball sports and had a good prognosis. The vast majority of these fractures could be treated conservatively yielding good outcome. Level of Evidence: Level IV, case series.

Innovative scald burn model and long-term dressing protector for studies in rats.

R are frequently used for experimental studies in burns. Scalding is the easiest mechanism for provoking a dermal burn; the ability to vary water temperature, time of exposure, and the burned area make this method effective for reproducing almost any kind of thermal wound. Last but not least, rats are readily available, inexpensive, and easy to manage. In general, a scald injury in rats is inflicted on anesthetized animals by immersion of the area to be burned into a water bath. The area of exposure is determined by the aperture in the template, which can be an elaborately designed apparatus, a metal wire cage, or a simple metal plate with a rectangular aperture through which the body part is immersed in a water bath for a specified amount of time. To establish a standard long-term method for protecting the burn wound dressings from being eaten by the rats and thereby tainting the scientific results, we searched the relevant literature and found that there was nothing available for that purpose. After several tests, the armor described later used together with our scald template was found to be satisfactory for our experiment series. With the use of the armor, the silver detected in the blood should originate only from the wound, with no additional absorption from the gut. In this article, an innovative scald protocol and armor are being presented.With this template firmly pressed on the shaved back, only the area to be burned is in contact with the boiling water. The burn wound is uniform in size and depth and can certainly be reproduced. The template is easy and fast to fabricate at a low cost and at any size. The armor ensures that the dressings stay in place for a minimum of four or even more weeks and prevents the rats from eating the silver-coated wound material.

A Rare Cause for a Neonatal Cystic Abdominal Mass

Intrauterine ovarian torsion is a rare event, but it is a possible cause for unilateral ovarian aplasia. Most commonly the ovary undergoes autolysis after torsion so that no tissue or remnants can be discovered on the involved side. We report a rare case of unilateral intrauterine torsion followed by autoamputation and abdominal reimplantation resulting in an intra-abdominal complex cystic mass with a review of the literature.